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South Dakota rates for HCPCS L5646

Addition to lower extremity, below knee (BK), air, fluid, gel or equal, cushion socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $630.96 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $512.86 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,071.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $851.14 / $2,290.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $501.19 / $4,265.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $724.44 / $724.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $1,513.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $851.14 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $489.78 / $776.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65